Key result
Aspirin cuts nonfatal ischemic stroke by ~22%, though proves less effective than warfarin in AF.
Why the study?
The efficacy, side effects, cost, and hemorrhagic complications of antithrombotic agents vary, requiring consideration of stroke subtype and thromboembolic risk predictors to direct treatment choice for stroke prevention.
Aspirin is the most widely used antiplatelet agent, reducing nonfatal ischemic stroke by 22%. There is increasing evidence that the efficacy of aspirin may vary with the etiologic subtype of stroke. Although the cost and side effects have limited the use of ticlopidine, patients who are intolerant of aspirin and those experiencing transient ischemic attack or stroke during aspirin therapy should be given ticlopidine. Patients with atrial fibrillation have a five-fold increased risk of stroke and require prophylactic therapy with warfarin or aspirin. Aspirin is less effective than warfarin in preventing atrial fibrillation-associated stroke, but the higher risk of hemorrhagic complications and frequent monitoring associated with warfarin must be considered. Clinical and echocardiographic predictors of increased thromboembolic risk in atrial fibrillation patients have been identified and may direct the treatment choice.
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Solomon et al. (1994) conducted a review in Stroke prevention and atrial fibrillation. Antithrombotic therapies (aspirin, ticlopidine, warfarin) was evaluated on Nonfatal ischemic stroke (22% relative risk reduction). Aspirin reduces nonfatal ischemic stroke by 22%, though it is less effective than warfarin for preventing stroke in patients with atrial fibrillation.
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